J-1 Work Authorization Request Form

Student's Last Name

Student's First Name

Student's Email

University ID Number

Employer Name

Employment Department (ex. Food Services)

Number of Hours Per Week*

Employment Begin Date (dd/mm/yyyy)

Employment End Date

Employment Type

* Please note that on-campus employment is limited to 20 hours/week maximum while school is in session. Full time during official school breaks. Academic Training can be authorized on a full time basis for Co-op positions, or post-graduation positions.

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